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University College London (UCL) 2022

A holistic exploration of risk factors and transmission pathways to enteric infections in infants. A case study in rural tribal Rajasthan, India

Vila Guilera, Julia

Titre : A holistic exploration of risk factors and transmission pathways to enteric infections in infants. A case study in rural tribal Rajasthan, India

Auteur : Vila Guilera, Julia

Université de soutenance : University College London (UCL)

Grade : Doctor of Philosophy (PhD) 2022

Résumé
Globally, enteric infections are the third leading cause of child mortality, and they contribute to child malnutrition and stunting. Safe Water, Sanitation, and Hygiene (WASH) should interrupt infection transmission ; however, recent WASH trials have shown little impact on child infections and growth outcomes. This thesis addresses the need to better understand the multiple and complex factors contributing to infants’ enteric infections, adopting a holistic, interdisciplinary approach. A mixed-methods case study was conducted in 9 tribal villages of Rajasthan, India. Qualitative data were collected from 9 transect walks, 63 hours of household observations, 12 interviews, and 4 group discussions with infant caregivers and were analysed thematically. Quantitative data were collected from 42 household surveys, 47 structured infant observations, and 316 environmental samples tested for faecal bacteria and analysed in a microbial risk assessment. Multiple cross-sectoral factors contributing to infants’ enteric infections were observed : an arid climate, earthen households, domestic animals, no toilet facilities or handwashing with soap habits, weak governance systems, low emphasis on WASH promotion and infection risk awareness health services, limited livelihood opportunities, and tribal attitudes of limited self-efficacy. Faecal contamination was widespread, with 90% of environmental samples positive for faecal bacteria. Risk assessment results estimated that by their second birthday, infants had a median accumulated risk of enteric infection of over 71% from drinking and bathing in local waters and 100% infection risk from mouthing soil while crawling on the earthen floors. Tailored recommendations to enhance infant hygiene and infection prevention were co-developed with local stakeholders. This thesis provides in-depth ground-level evidence from tribal communities in rural India. Given the multifaceted factors contributing to infants’ enteric infections and the widespread faecal contamination, transformational changes across sectors will be required to improve child health and development. Enabling the tribal communities’ self-efficacy may be crucial for future efforts towards the Sustainable Development Goals.

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Page publiée le 4 décembre 2022